Hydrocortisone
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Strongyloides hyperinfection syndrome causing pneumonia and ventriculitis: case report An 81-year-old woman developed Strongyloides hyperinfection syndrome leading to pneumonia and ventriculitis during corticosteroid therapy with hydrocortisone. The woman presented with poor oral intake, recurrent falls and palpitations. She received unspecified treatment for her underlying thyroid storm along with confusion and atrial fibrillation. She started receiving IV hydrocortisone 100mg every 8 hours since hospitalisation. On day 5 of hydrocortisone, she developed upper gastrointestinal bleeding. The woman underwent esophagogastroduodenoscopy following intubation for airway protection, which showed multiple gastric ulcers. Bronchoscopy and bronchial washings of her right upper lobe showed blood-stained returns. Cytology from the bronchial washings showed microfilaria, which was identified as Strongyloides filariform larvae. Bacterial culture from the bronchial washings grew Enterobacter cloacae and Citrobacter freundii. She received ertapenem along with ivermectin. Albendazole was added due to persistence of the larvae in her stool and endotracheal tube secretions. Brain MRI was performed due to deterioration in her conscious levels, which demonstrated bilateral ventriculitis. She was also found to have developed pneumonia. Bedside lumbar puncture showed pus-like cerebrospinal fluid, cultures of which revealed Enterobacter cloacae. She received meropenem. After 10 days, a repeat lumbar puncture revealed no bacterial growth. However, her stay in the ICU remained stormy with multiple complications from prolonged mechanical ventilation. Following 49 days of mechanical ventilation, she died of Strongyloides hyperinfection syndrome. She was found to have developed Strongyloides hyperinfection syndrome secondary to hydrocortisone. Seow D, et al. Strongyloides hyperinfection syndrome causing pneumonia and ventriculitis by enterobacter cloacae. American Journal of Respiratory and Critical Care Medicine 199: abstr. A6620, No. 9, May 2019. Available from: URL: https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2019.199.1_MeetingAbstracts.A6620 [abstract] 803447220
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Reactions 18 Jan 2020 No. 1787
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